PEDS Class 5

State some causes of acute diarrhea.

- Infection. - Associated conditions. - Dietary causes. - Medications. - Toxic causes. - Functional causes. - Other.

What are the clinical signs of moderate dehydration?

- Slightly increased heart rate, RR and BP. - Irritability. - Thirst. - Dry mucous membranes. - Minimal tears. - Normal anterior fontanel. - Cap refill > 2 seconds. - Specific gravity of >1.020

What are the clinical signs of severe dehydration?

- Tachycardia. - Increased RR. - Orthostatic to shock BP. - Hyper irritable. - Lethargic. - THIRSTY. - No tears. _ Sunken fontanels. - Delayed cap refill >4 seconds. - Oliguria or anuria.

Give examples of the common causes of dehydration.

- Vomiting, diarrhea, fever, tachypnea. - Dysphagia, decreased oral intake with increased activity. - Skin burns, phototherapy. - Tube feeds or increased gastric output such in abdominal surgery. - Renal failure, CHF, diabetes, and cystic fibrosis.

What are the 3 types of dehydration?

1. Isotonic. 2. Hypotonic. 3. Hypertonic.

What are the 3 degree of dehydration?

1. Mild. 2. Moderate. 3. Severe.

State the 4 goals of fluid therapy.

1. Prevent dehydration. 2. Prevent electrolyte abnormalities. 3. Prevent protein degradation. 4. Prevent acidosis and circulatory collapse.

What are the clinical signs of dehydration? State them in order starting from the earliest detectable sign.

1. Tachycardia. 2. Dry skin and mucous membranes. 3. Sunken fontanels. 4. Signs of circulatory failure - coolness and mottling of extremities. 5. Loss of skin elasticity. 6. Prolonged capillary filling time.

Patient: 33 pound child. Calculate the hourly fluid requirement.

33 lbs = 15kg. 10 x 100 = 1000ml. 5 x 50 = 250ml. 24 hours = 1250ml. 1250/24 = 52.08mL/hour.

Patient: 43 pound child. Calculate the hourly fluid requirement.

43 lbs = 19.5kg. 10 x 100 = 1000mL. 9.5 x 50 = 475mL. 24 hours = 1475mL. 1475/24 = 61.46mL/hour.

Normal body pH:

7.35 to 7.45.

What is a nursing diagnosis for dehydration caused by diarrhea?

Excess fluid in small intestine related to bacterial toxins, inflammation, or increase intestinal motility.

A diarrhea caused by infection from bacteria such as E.coli, Salmonella, Shigella, campylobacter or from virus such as rotavirus, enteric adenovirus through ingestion of contaminated food and/or water.

Gastroenteritis.

A type of dehydration that results from water loss in excess of electrolyte loss and is usually caused by a proportionately larger loss of water or a larger intake of electrolytes.

Hypertonic dehydration (hyperosmotic or hypernatremic). Fluid shifts from the lesser concentration of the iCF to the ECF. Plasma sodium concentration is greater than 150mEq/L.

Which type of dehydration is the most dangerous and requires much more specific fluid therapy?

Hypertonic dehydration. Neurological disturbances such as seizures, disturbance of consciousness, poor ability to focus attention, lethargy, increased muscle tone with hyperreflexia, and hyperirritability to stimuli are more likely to occur.

A type of dehydration that occurs when the electrolyte deficit exceeds the water deficit. Water transfers from ECF to the more concentrated ICF thus increasing the ECF fluid loss resulting in shock.

Hypotonic dehydration (hyposmotic or hyponatremic). Physical signs tend to be more severe with smaller fluid losses than in isotonic or hypertonic dehydration. Plasma sodium concentrations are typically less than 130 mEq/L.

What happens in hypovolemic shock? What are its clinical signs? What are its common causes?

Hypovolemic shock happens due to decrease in circulating volume in ECF. Clinical signs include decrease in blood pressure and cap refill. Common causes are blood loss, plasma loss and ECF loss.

A type of dehydration that occurs in conditions in which electrolyte and water deficits are present in approximately balanced proportions.

Isotonic Dehydration or Isonatremic. This is the most common type of dehydration in children.

Degree of dehydration: Less than 3% of body weight in older children or less than 5% of body weight in infants are dehydrated.

Mild dehydration. Oral rehydration therapy, water or pedialyte are given.

Degree of dehydration: 5% to 10% weight loss in infants and 3% to 6% in older children.

Moderate dehydration.

Normal values Potassium in a newborn and thereafter.

Newborn: 3.0 to 6.0 mEq/L. Thereafter: 3.5 to 4.5 mEq/L.

What elements are found in the Intracellular fluid?

Potassium (K+) and Magnesium (Mg+).

Degree of dehydration: >10% loss in infants and >6% in older children.

Severe dehydration.

What is the greatest threat to life in isotonic dehydration?

Shock. The child with isotonic dehydration displays symptoms characteristic of hypovolemic shock. Plasma sodium remains within normal limits, between 130 and 150 mEq/L.

What elements are found in the Extracellular fluid?

Sodium (Na+) and Chloride (Cl-)

Normal values Sodium in a newborn.

Sodium: 135 to 145 mEq/L.

Why is vomiting considered as normal during infancy?

Due to immature esophageal sphincter.

This is the leading cause of illness in children younger than 5 years. It is very common and can be life threatening. This is also related to 24% of all deaths in developing countries.

Diarrhea + dehydration.

What are the clinical signs of mild dehydration?

Clinical signs include slight thirst and urine specific gravity of >1.020.